MEDICARE: MRS. KAREN K COMBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171WH0202X	Home Modifications Contractor	364757391	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508225004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KAREN K COMBA

Provider Business Mailing Address
First Line	:	4319 CHATEAU RIDGE RD
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80108-8424
Country	:	US
Telephone Number	:	303-807-1019
Fax Number	:	303-683-1527

Provider Business Practice Location Address
First Line	:	4319 CHATEAU RIDGE RD
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80108-8424
Country	:	US
Telephone Number	:	303-807-1019
Fax Number	:	303-683-1527

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2016
Last Update Date	:	07/08/2016

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